Basic Information
Provider Information
NPI: 1003139502
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAYNE
FirstName: RACHEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 234 MORRELL RD
Address2: SUITE 304
City: KNOXVILLE
State: TN
PostalCode: 379195876
CountryCode: US
TelephoneNumber: 8652460143
FaxNumber: 8652460146
Practice Location
Address1: 300 PROSPERITY RD
Address2: SUITE 103
City: KNOXVILLE
State: TN
PostalCode: 379234717
CountryCode: US
TelephoneNumber: 8652460143
FaxNumber: 8652460146
Other Information
ProviderEnumerationDate: 03/11/2010
LastUpdateDate: 05/03/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X14847TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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